Musculoskeletal disorders (MSDs) affect over 40 million Americans and are the leading cause of activity limitations. Health care costs for arthritis and osteoporosis alone exceed 75 billion dollars per year. In the past 5 years, there has been a dramatic rise in the number of new FDA approved therapies for MSD treatment. Society faces difficult questions of how best to use new versus existing therapies in an equitable, efficient and cost-effective fashion. The long-term objective of this proposal is to establish a self-sustaining Center for Education and Research on Therapeutics (CERT) of MSDs. The CERT will combine substantial UAB clinical and health services research expertise with private sector collaborations to evaluate the effectiveness and safety of new MSD therapeutics and to guide changes in the practice community. The specific aims of the CERT are to establish a core facility that will be utilized to: 1) In collaboration with AHCPR/FDA, conduct outcomes and effectiveness research on high profile MSD projects that are generated internally, from our partners in managed care organizations and in the pharmaceutical industry, and from other CERTs. Our CERT will use both private and public national data sources and will build on the diverse resources of UAB Schools, Centers, and Programs; 2) Identify variations in the use of MSD therapeutics and explore the causes of these variations in practices by examining their association with scientific evidence, provider, care system, patient and community characteristics; 3) Using previously well-tested methodology, effectively disseminate new knowledge about MSD therapeutics to practitioners, insurers, policy makers, and the general public. Emphasis will be placed on altering provider behavior via education on evidence-based guidelines, quality of care indicators, and peer performance. A study of glucocorticoid-induced osteoporosis, an endemic problem that is currently inadequately treated, highlights selected CERT capabilities. Other demonstration studies addressing arthritis and osteoporosis problems of high current interest are also proposed. The UAB CERT, a cooperative agreement with AHCPR, will encompass broad and rapidly emerging therapeutic areas in all MSDs that affect predominantly older and other high-risk populations. We demonstrate that future viability of the CERT will follow form our broad-base of public and private sector support. Our findings and interventions will address health care policy concerns of significant National importance.